Nutrition Counseling Strategies. Linda Adams, RD

Transcription

1 Nutrition Counseling Strategies Linda Adams, RD

2 Every 60 seconds someone dies from a heart attack in the U.S. Every 4 minutes an American dies from stroke Every 20 seconds someone suffers a heart attack in the U.S.

3 Poor dietary habits are a cause of chronic disease We know this! Do most people know this?

4 Top 10 causes of death 1)Heart disease 2)Cancer 3)Chronic lower respiratory disease 4)Stroke 5)Accidents 6)Alzheimer s disease 7)Diabetes 8)Influenza and pneumonia 9)Kidney disease 10) Suicide

5 Top 10 causes of death How many are diet/lifestyle related? 1)Heart disease 2)Cancer 3)Chronic lower respiratory disease 4)Stroke 5)Accidents 6)Alzheimer s disease 7)Diabetes 8)Influenza and pneumonia 9)Kidney disease 10) Suicide

6 Top 10 causes of death How many are diet/lifestyle related? 1)Heart disease 2)Cancer 3)Chronic lower respiratory disease 4)Stroke 5)Accidents 6)Alzheimer s disease 7)Diabetes 8)Influenza and pneumonia 9)Kidney disease 10) Suicide

7 Basics of Healthy Eating Balanced Plate concept including: Whole Grain products Fish 2 3 times a week More plant based proteins Non-fat dairy products Use liquid oils Eat smaller portions Avoid Sugared beverages Don t Skip meals Focus on the every day and sometimes food lists.

8 Eat sometimes

9 Enjoy everyday!

10 Foods that should be sometimes foods

11 Suggest substitutions

12 Foods that should be sometimes foods

13 Foods that should be sometimes foods

14 Basics of Healthy Eating

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16 Basic nutrition recommendations To help prevent chronic disease Watch out for added sugar <10% calories from

17 Basic nutrition recommendations To help prevent chronic disease

18 Decrease use of foods in a can, box, bottle, jar Increase use of foods that are in the form they come from the earth. Emphasize use of frozen veggies for convenience. Making food at home will decrease your sodium intake

19 Watch out for added sugar Select cereal with less than 8 gm or less sugar Encourage un-sugared beverages Sugared beverages once a week! Sugary candy should be an exception, not the norm 1 teaspoon (cube) = 5 gm

20 Plant fats VS Animal and processed plant fats

21 Add them to sandwiches Get creative with salad! Make a veggie stir-fry! Steamed or raw!

22 Problem habits you may encounter Calorie dense sweetened beverage consumption Low intake of fruits and veggies Lack of meal structure Lack of physical activity Smoking and alcohol consumption

23 Problem habit: low F/V Talk about strategies to purchase Frozen Canned Fresh seconds Where to get free F/V

24 Problem habit: calorie dense, sweetened beverages Educate Use sugar cubes as a visual no nutrients Equate calories. What nutrients are there? F/V intake tends to decrease with increased sugared beverage consumption

25 Problem habit: Lack of mealtime structure Lack of mealtime structure Skipping breakfast is associated with increased BMI. Work/school schedules interfere Lack of time Lack of motivation

26 Nutrition Peer Counseling Nutrition Peer Counseling is a great resource for students. Allows them to feel confident they are getting good information.

27 Fit-well Nutrition Peer Counseling Internship Peer Nutrition Counseling Services: Drop-in Peer Nutrition Consultations Bulletin Board displays Lobby work Campus work Healthy Aggies Blog Newsletter Social media presence Workshops virtual or in ARC Additional activities: Developing posters for ARC Fit-well services to promote: Body Composition Personal Training

28 Fit-well Nutrition Peer Counseling Internship Peer Nutrition Counseling Scope: Dietary Guidelines for Americans Choose myplate Balanced plate eating pattern Outside of our scope: Diet prescriptions Specific advice related to treating a disease (as opposed to general information)

29 Fit-well Nutrition Peer Counseling Internship Important skills to use/develop Listening skills Empathy Clear pattern of speaking Probing questions Reflection Reframing Summarizing

30 Nutrition Peer Counseling How does the community sign up? o Personal Training Initial Package o Diet Analysis ($20) Drop-in sessions (2 hour blocks) Education tabling

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33 Nutrition peer counselor roadmap (1) A counseling session may take this path: Talk briefly about the diet analysis results allow the client to refer to the Deciphering document on their own. (or food frequency form using MI). Based on results, talk about one area you feel the person could benefit from (e.g. more fruits and vegetables, more whole grains, etc). Listen and reflect. Ask how much of this food group they eat during a day Ask what they like (dislike) about this group of foods Ask if they know how much they should eat? If not, ask if they would like to know the recommendation. Listen and reflect Talk about values that they hold that may make the change easier Ask what their top 3 values are and what that means to them Listen and reflect Ask what connection, if any, the person sees between these values and eating more of the food group. Reflect on the connection or lack of.

34 Nutrition peer counselor roadmap (2) Rate importance and confidence Ask them what number do they rate themselves at for importance and confidence Why they chose that number and not a different number What would it take to move the number higher Listen and reflect Create action plan/summarize/close Ask if the person has some ideas for ways to eat of the food group. Listen and reflect If not, with permission, suggest some ideas and ways to get info. Ask if any of these ideas might work for them. Listen and reflect Summarize the key parts of the conversation Ask if the person would like to check back in in about 2 weeks.

35 Nutrition Peer Counseling What do drop-in sessions look like? Reframe these as Nutrition Peer drop-in sessions

36 Resources and clearing house Healthyaggies.weebly.com

37 Nutrition Peer Counseling Training Part 2

38 Successful communication / counseling

39 Successful communication

40 Successful counseling

41 unware => problem aware => solution aware => action

42 Tips for conversation:

43 unaware => problem aware => solution aware => action What do they know? Their doctor says they have a problem They are overweight They feel tired They have headaches They (especially in our case) may not have thought about it much!

44 Opening the interview Opening goals: Connect with the client make them feel at ease o Introduce yourself and ask them about themselves o Allow time for small talk

45 Use Probing questions

46 Use Probing questions

47 What is an open question? Can t be answered with yes or no ; answers typically give a lot of information Allow for a fuller, richer discussion Are non-judgmental Let the people you re counseling think out loud Allow them to do most of the talking, using their own words Let them know the conversation is about them. What is a closed question? Can usually be answered with yes or no Let the person asking the questions do most of the talking Can be judgement because they can force a person into a certain answer.

48 What do you think about eating more fruits and vegetables? Can t be answered with yes or no ; answers typically give a lot of information Allow for a fuller, richer discussion Are non-judgmental Let the people you re counseling think out loud Allow them to do most of the talking, using their own words Let them know the conversation is about them. Additional things you might learn: Their motivations or barriers Their health concerns The influence of friends or family Information that help you understand them and tailor the message to them. Make it personal.

49 Examples of open and closed Qs Open Why did you sign up for nutrition peer counseling? Tell me about some of the fruits and vegetables you like to eat. What kind of fruits and vegetables do you like? How, if at all, have your eating habits changed over time? What would help you to eat more fruit and vegetables? Closed Are you interested in eating a healthier diet? Do you want to eat more fruits and vegetables? Do you like fruits and vegetables? Do you still eat the same foods now as you did a few years ago? Is cost a problem for you?

50 Starters for open and closed Qs Open Tell me about To what extent What else? Help me understand How did you What, if any Closed Do you Will you Can you Is it Are you Are you

51 How would you tell which stage I m in? I drink at least three, sometimes more, 20 oz colas daily. I have told you that in my diet recall. What do say to me?

52 Practice We ll be practicing turning some closed questions into open ones! We ll go around the room.

53 Practice Do you like fruit?

54 Practice Do you enjoy trying new fruits and vegetables?

55 Practice Is it difficult for you to find time to cook?

56 Practice Do you eat meals regularly?

57 Practice Are you ready to start drinking more water?

58 Summary of open and closed Qs Open: Let the other person talk Cast a broad net Keep the ball rolling Are not biased Make few assumptions Are not judgmental People respond with: More information In their own words. Closed: Let you do most of the talking Are very specific Stifle conversation Might imply the right answer Narrow the choices May force agreement People respond with: Brief, yes or no answers Without explaining or opening up.

59 What is reflective listening? Active listening listening to both the words and the emotions behind the words Keeps people thinking and talking Forces you to listen so that you can reflect back to the person What is a reflection? Reflects, as a mirror, what people have said or what they are feeling. Lets you check that you re understanding correctly and indicates you re trying to understand. Opens the door for people to keep talking. It is NOT giving advice and NOT a question.

60 Reflective listening? Consider these two scenarios

61 Reflective listening? Belinda: Girl, you know, that speaker really got me thinking today about how I eat. My blood pressure being high and all. Nanette: You re right. You d better do something. You saw what happened to Wyatt s uncle? Belinda: Right out of the blue. Nanette: I m telling you, you d better stop eating that greasy food. Belinda: I know you re right. But it s not that easy. I mean who has time to shop and eat right, and buy the right thing? Thoughts?

62 Reflective listening? Listen again

63 Reflective listening? Belinda: Girl, you know, that teacher really got me thinking today about how I eat. My blood pressure being high and all. Nanette: Sounds like the speaker really got to you today. Belinda: Yes, he did. You know, it s really something about the body/food connection. Nanette: Yeah it is, that message has made you want to eat a little healthier. Belinda: Yeah, I think I m ready for myself, but I m not sure about the kids. They re kind of impossible to cook for because they don t go for that healthy stuff. Nanette: So what you re telling me is that the kids need to eat healthier, but that will take some time. You re ready to start now for yourself? Belinda: Yeah, I think I m ready to start for myself. I think I better take care of myself first. Nanette: So, tell me about some of those ideas you re going to try. Belinda: Well, at work, in the afternoon, maybe I could eat an apple instead of chips, and I could eat a banana for breakfast in the morning. Nanette: Hmm. Sounds like a piece of fruit is the way to go. Belinda: Yes. I think I could do that.

64 How do peer counselors use reflective listening? Listen and reflect what they hear. Remain supportive and non judgmental Help people find their own solutions by letting them sift through their thoughts and feelings. This can help them set realistic goals and decide how to achieve them. Don t give advice or try to solve problems.

65 Reflective Listening Tips Reflections end with a drop in the voice, not an upturn. An upturn makes a reflection sound like a question. Don t worry about being perfect. There are many possible reflections to every statement. If you re confused about what the person means, you might say: I m not sure I fully understand what you mean. Let me see if I have this right It s OK if the person says no. Use no s as a clue to change direction. Avoid phrases like you need and you have a problem These sound judgmental. Someone people may make a statement like, My boyfriend loves me no matter what I eat. A simple reflection such as, You feel certain of your boyfriends love will keep the conversation going in a positive direction. Avoid phrases like you should or you could These are lead-ins to giving advice. Remember, just thinking about eating more fruits and vegetables may be a good first step for some people.

66 Practice We ll be practicing turning some reflections next. We ll go around the room.

67 Practice Being so busy with school, I find I just don t cook the way I used to.

68 Practice I used to eat lots of fruit, but then I heard it causes diabetes.

69 Practice I know they re good for me, but I just don t have time to prepare vegetables.

70 Practice My mother always told me to eat lots of fruits and vegetables if I wanted to grow up to be strong and healthy.

71 Practice I eat lots of fruits and vegetables in the summer, not the rest of the year.

72 Summary of reflective listening Reflections: Can be about what was said, or about the emotions behind what was said. Move you closer to a better understanding of the key issues involved. Show that you are listening an that the person s thoughts and feelings matter to you. Encourage conversation Build rapport Don t need to be perfect. Reflections let you: Learn more Be supportive Be non-judgmental Reflections let the person: Voice thoughts or feelings they may not have talked about before. Feel understood Feel accepted without judgment Hear their thoughts and feelings restated Make themselves clear by adding to or changing what they have said. Talk about all sides of an issue Set realistic goals and decide how to achieve them.

73 Building Motivation? Nutrition peer counselors help people build motivation by: Connect personal values to a healthier diet Identifying the perceived benefits and barriers to eating more healthfully. Boosting confidence to take action. Tips for talking about values Stay neutral/non-judgmental some people will see the connection between their values and their eating habits. Some won t. That s o.k.. It is important for people to make the connection themselves. Reflect. Be sure to make reflections while people are discussing their values. This shows that you are listening and that you understand the reasons for their choices.

74 Importance and confidence Motivation is a combination of the two importance and confidence. Importance how important is it to a person to eat more fruits and vegetables. This is based on the personal benefits they see to doing so. Confidence how confident, or sure a person is about their ability to change their eating habits. Key to making changes.

75 Motivation importance and confidence One person may think it s important to eat more fruits and vegetables but they lack confidence to do so. Another may feel very confident they can change their habits, but may not think it is important to do so. Understanding both issues can help a person develop a realistic plan of action. How much do I want to make this change? What could get in my way? What could help? What would my first step be?

76 If the person is ready If the client has confidence and feels a change is important, you can help develop a realistic action plan: Ask if the person has some ideas for eating more fruits and vegetables Reflect on these ideas in a way that provides support for a plan: You can see yourself and sticking with it. If the person doesn t have a plan, provide guidance: Get permission to share some ideas that have worked for others Share information from your experience. Ask if any of these ideas could be useful Reflect in a supportive manner. If the person doesn t develop a plan, that s OK. You may reflect: You re interested in eating more fruits and vegetable, but you re not ready to start yet.

77 Summarizing thoughts and plans This will help the person get more out of the counseling session. The summary restates the key parts of the conversation and may include: Thoughts Concerns Plans Reflections especially those that produced a strong reaction. Tips for summarizing Take notes. Focus on Why the person feels it s important to eat more fruit and vegetables, or what gets in their way. Their level of confidence Concerns about eating a healthier diet. Values and benefits that may act as motivators Any plans that have been discussed.

78 Questions?